Category Archives: Med students book discussions

Is There a Doctor in the House?

DOC(1)Some of my friends and family members think that I have become a new convert to the dark side. This disturbing assessment is attributed to my fascination with the plethora of the newest iPhone health devices. I plead inter spem et metum or take up my daily residence somewhere between hope and fear on this subject. That is, I am hopeful about some of the latest technology that helps us monitor the heart, while I am fearful that our focus on the technology might contribute more to the dehumanization of health.

As a recovering heart patient and educator, I want to take the high road here and share my recent discovery of Professor Todd Savitt’s edited book, Medical Readers’ Theater: A Guide and Scripts, published by the University of Iowa Press.

The paperback comprised of fourteen theater scripts is adapted from short stories about physicians and patients. All of the stories (scripts) address ethical and social issues in medical care and the conflicting aspects of aging and chronic disease. While the text or scripts may be intended for medical students, I urge my colleagues in the performing arts, and humanities to assign the textbook. For that matter, here at Coastal Carolina University, where I currently teach, it may be a welcome addition for our expanding Health Promotion department. What better way to offer some instruction in empathy.

The Readers’ Theater Program began in 1988 with a grant from the North Carolina Humanities Council. Three medical schools in the state sent students to perform the stories before community groups. The program continues at East Carolina University, and thanks to this book, it can be inaugurated at other institutions.

Savitt, a PhD in the Department of Bioethics and Interdisciplinary Studies at Brody School of Medicine, gives more than thoughtful instructions on how the material is to be performed—including brief stage directions and suggestions on what performers should wear—and he offers tips on finding audiences by reaching out to existing organizations and community groups.

The job of the discussion leader is carefully detailed because the purpose of the performance is not to provide entertainment, but to elicit an exchange of ideas. The program, he explains, “is to provide a forum where citizens can consider and examine their own and others’ views on issues of common concern in the medical world” (p. xix). It is fully anticipated that attendees will be “sharing personal and sometimes painful experiences and debating points of contention” (p. xix).

The reader is not only an essential for medical students but for all students engaged in the healthcare field. I encourage all medical schools to take the lead and dedicate one afternoon to a Medical Readers Theater performance with faculty, students and patients all participating.

The stories found in the compelling anthology include a range of themes about physicians and patients, like William Carlos Williams’s “The Girl With a Pimply Face,” a story that I have previously taught in one of my past Literature and Medicine classes. An excellent summary of this story is found on this blog, Medical Visions in Literature Discussion.

For my purposes, I intend to rally some academic departments to conduct a Medical Readers performance this fall. Anything that teachers can do to bring empathy into the classroom has my vote and full participation. After all, empathy is not just about hugs and pats on the back for a job well done. It’s about developing a skill that can make young people more mindful and productive at home, on campus and eventually in the workplace since we need more cooperation and compassion each and every day.

Send me your story.

Tell A Good Story to Your Doctor

A highly recommended read for all patients

I enthusiastically agree with blogger/writer, Deborah Kotz in her recent review of Drs. Leanna Wen and Joshua Kosowsky’s patient empowering book, When Doctors Don’t Listen How To Avoid Misdiagnosis and Unnecessary Tests. Kotz writes, ” I always admire doctors who can write books criticizing their own profession, including any shortcomings they may have as practitioners – in an effort to improve patient care.”

The author physicians recognize that narratives are a vital part of medicine. After all, stories about patients, the experience of caring for them and the hopeful recovery from an illness is always a shared story linking the doctor, the patient and family. I know this from my own heart journey following a difficult and perilous triple bypass a few years ago. For sure, the medical narrative is rapidly changing from the doctor’s story to the patient’s narrative.

Wen and Kosowsky restore our faith in good and effective medicine that can and should be practiced. In so many ways I champion them for their important contribution to the rehumanization of medicine in the same way as patient narratives.

In increasing numbers, the new crop of medical students and youthful white coat practitioners recognize that narrative medicine continues to emerge in response to a arteriosclerotic health care system that places bureaucratic budgetary concerns over the needs of the patient. These two author doctors in their timely book offer understanding that there’s a river of confluent sources spilling over  the former dam of evidence-based medicine to a new novel narratology practiced among doctors and patients.  A recent Wall Street Journal article reinforces this claim.

” The art of medicine, by contrast, relies on spending time with patients to take an accurate medical history, listening to all their symptoms and concerns and using common sense. During medical training, that art can get lost in the demands of mastering the science.”

Several weeks ago at an American Medical Student Association Humanities Institute I was rewarded by the conversations and stories produced by medical students in a workshop I conducted on the writing of illness narratives.

I want to credit blogger Deborah Kotz, who concisely and cogently offers this summary of the book’s recommendations for patients the next time we are in the doctor’s office or even emergency room.  Here’s what the authors recommend.
1. Tell a good story. Start at the beginning and proceed chronologically highlighting the most important parts in five minutes or less if possible. Don’t use medical jargon that you may have heard on a TV show like Gray’s Anatomy. Doctors have specific definitions for terms like “radiating” or “palpitations” that may differ from what you’re actually experiencing. If your doctor tries to interrupt your tale with questions, take a breath and ask to continue before the questioning.
2. Always provide context. What was happening in your life when the symptoms started? If they’ve recently gotten worse, explain what you think may have exacerbated them. This will help your doctor to think beyond the set diagnostic protocol and see you more as an individual.
3. Describe symptoms as specifically as possible during a physical exam. If you feel the pain in only one spot, make that known. Also, let your doctor know whether it’s sharp or dull, intermittent or constant. Pain scores that doctors traditionally use — 1 to 10 with 1 being mild and 10 being akin to the worst torture — can often be misleading since a patient’s definition of a 10 maybe very different from a doctor’s.
4. Get a differential diagnosis. Doctors should have more than one diagnosis in mind initially to make sure that all bases are covered. Usually, a doctor will strongly suspect one particular condition while considering a few others. For example, you might be told you likely have a migraine but that if the pain doesn’t abate at all over the next week, you might need a brain imaging scan to rule out a tumor. “Be wary if your doctor seems to focus on one particular disease to rule out,” write Wen and Kosowsky.
5. Ask for the reasons behind every medical test. Your doctor should be able to explain what the test is looking for, how likely you are to have that diagnosis, and whether your treatment plan will change based on that diagnosis. Every test, even a simple blood draw, has risks, according to Wen, so they should all be done for a reason.

Medical Students Engage Illness Narratives in Webinars

As the year draws to a close, I want to share some details about the impressive American Medical Student Association’s Medical Humanities Scholars Program. A few weeks ago, I joined the conversation in an “Illness Narratives” webinar facilitated by the energetic Aliye Runyan, who shares her AMSA supported MHSP duties with her medical student association colleagues, Gabriela Magda and Maggie Reid Schneider.

For sure, these are busy and stressed medical students. This is especially true for Aliye Runyan, a fourth year medical student, who is scheduled to graduate in 2012 from the University of Miami Medical School, where she plans to specialize as an obstetrician-gynecologist.

I met her last April at The Examined Life Conference supported by the University of Iowa Writing Program and Carver College of Medicine.This noteworthy three-day conference focused on the links between the science of medicine and the art of writing.

In an e-mail, the future doctor informs me that she “founded the AMSA Medical Humanities Scholars Program in 2008 to provide a much needed outlet for humanities education within medical education.” Turning a page from her mentor, Dr. Rita Charon, Runyan joins an increasing number of physician writers who are now writing their prose and poems.

It is very encouraging to hear these future doctors express their interest in learning to read stories and to listen to patients. At a time when doctors have less and less time to spend with patients, poems and stories matter now more than ever. There is increasing agreement among physicians that every patient’s story, whether it be through the admission report, the medical chart, or the arc of an entire life history, is a valued narrative. After all, the patient approaches the physician with one simple question, “My story is broken. Can you fix it?”

In our recently held web conference, participants like Junzi Shi, a first year medical student at the University of Cincinnati, joined others engaging in thoughtful responses to one of the assigned readings. I had sent out an e-mail encouraging students to read Meghan O’ Rourke’s “Story’s End” published in The New Yorker. In the essay, the author poignantly expresses her grief for her mother’s death.

Shi, born in Lanzhou, China, says that she joined MHSP ” to learn about the role that patients’ illness narratives play in their healing process. ”

Others like Sarah Selem, a first-year medical student at the University of Miami School of Medicine is enthusiastic
about participating in the Medical Humanities Scholars Program since it deepens her understanding about how science and the humanities can be used in medicine to care for others.

From the conversations and responses shared with these students, it seems that they do understand that medicine is both an art and science. By exploring medicine through the prose and poems of patients, all of us gain insight into the nature of the human condition, of suffering, of renewal and sometimes of transformation.

All this seems very encouraging since AMSA has over 150 chapters in medical schools across the country and as many as 350 pre-med chapters. This translates into more than 68,000 members, including medical and premedical stuents, residents and practicing physicians.

Certainly there appears increasing interest among medical educators to help both experienced physicians and medical students approach the challenges and at times, conflicts between patient care and health system demands. While the study and integration of literature or the place of story in the medical curriculum does not provide all the answers, it does complement and enhance better medicine.

Send me your story.

Medical Students Tune In to Doctor Stories

The idea of combining literature and medicine– or narrative medicine as it is called—has been part of the medical education for over 45 years. Studies continue to reveal that such literary training strengthens and supports the compassionate instincts of doctors. This is even becoming more widespread among the ranks of medical students since more and more medical schools and medical centers are adopting narrative programs of study in reading, writing, reflecting and bearing witness to one another’s ordeals.

Thanks to the leadership of Lorenzo Sewanan and the American Medical Student Association (AMSA), there’s also a Medical Humanities focused National Book Discussion Webinar Series. On June 30, Dr. Lisa Sanders, author of Every Patient Tells A Story is the keynote presenter. Her monthly “Diagnosis” column in The New York Times Magazine was the inspiration for the hit TV series House.

The association offers an interactive medium opportunity for readers to listen to authors engaged in medicine. Click this link for more information and registration.

Previous webinar authors have included: Dr. Vincent Lam, Bloodletting & Miraculous Cures, Sayantani DasGupta MD and Marsha Hurst PhD, Stories of Illness and Healing: Women Write Their Stories, and Dr. Augustus White, Seeing Patients: Unconscious Bias in Health Care.

This kind of programming brought to us by medical students, reinforces what Barry Lopez wrote. “ Everything is held together with stories. That is all that is holding us together—stories and compassion.”

While few medical students do not major in English or literature, it’s most encouraging to know that an increasing number of future white coats are immersed in stories. Who knows with these continuing and inspiring literary medical webinars, we may be hearing soon from another Anton Chekhov, Michael Crichton, Robert Coles, W. Somerset Maugham, William Carlos Williams and Abraham Verghese.

I am reminded of what Dr. Rita Charon has written about the intersection of medicine and literature. “ The bonds between medicine and literature are natural and nourishing, for doctors are storytellers, intimates of strangers, seekers of plot, diviners. We do our work by listening to stories and knowing the meaning of things.”

Stay tuned. And please send me your story.